TWO CASES OF LAPAROSCOPIC PARTIAL GASTRIC RESECTION FOR EARLY GASTRIC CANCER, THE LOCATION OF WHICH MADE IT DIFFICULT TO PERFORM ENDOSCOPIC SUBMUCOSAL DISSECTION

Abstract

Endoscopic submucosal dissection (ESD) for early gastric cancer has gained popularity and its indication has been expanding recently. Although elevated early gastric cancer is a good indication for ESD, the difficulty of the procedure depends on the location of the tumor. We report on two cases of early gastric cancer treated with laparoscopic partial gastric resection (LPGR) because the tumors were both located at the top of the fornix, which was considered to be a difficult location for ESD. ESD for gastric cancer located at the fornix or the greater curvature is technically difficult because of breathing fluctuation, and the rate of complications, such as bleeding and perforation, is relatively high. On the other hand, LPGR has an easier approach for resecting those areas of the stomach with minimal invasion. En bloc complete resection is possible when preoperative endoscopic marking is performed. LPGR should be considered as an alternative to ESD for treating early gastric cancer when the tumor is located in a difficult area.